Dermatology

Question 1

differentiating vitiligo from pityriasis versicolor?

Answer 1

Vitiligo-depigmentation
Pityriasis versicolor-hypopigmentation

Question 2

What is erythema multiforme major?

Answer 2

Erythema multiforme is an acute, immune-mediated skin condition that typically presents with target-like lesions on the skin and mucous membranes (eyes and mouth). This condition can be triggered by infections (commonly herpes simplex virus or mycoplasma pneumoniae) or medications.

Question 3

Describe seborrhoeic dermatitis?

Answer 3

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale).

Causes itchy rash affecting the head : scalp (may cause dandruff), periorbital, auricular and nasolabial foldsdistribution is commonly caused by seborrhoeic dermatitis, causes ill-defined, pink coloured patches with a yellow/brown scale.

If untreated can lead to blepharitis and otitis externa

the first-line treatment is ketoconazole 2% shampoo

AKA as cradle cap in children

Question 4

What is the management of psoriasis?

Answer 4

regular emollients always

first-line:
steroid + vit D analogue (separate) OD

second-line: no improvement after 8 weeks - vitamin D analogue BD

third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily

In secondary care: phototherapy, biological agents

Question 5

How do you treat Pityriasis versicolor

Answer 5

topical antifungal.- ketoconazole shampoo

Question 6

Superifical spreading vs nodular vs lentigo vs acral melanoma types?

Answer 6

superficial: most common, typically flat patch of pigmented skin which grows slowly. It can be recognised by an ABCDE approach. Younger people.

Nodular: 2nd most common. Older people. Red or black lump or lump which bleeds or oozes

Lentigo:elderly, slow growing

Acral: Nails, palms or soles, People with darker skin pigmentation. Hutchinsons sign (nail)

Question 7

What is the name of the rash that appears in lyme disease?

Answer 7

Erythema chronicum migrans (‘bulls-eye’) rash occurs in around 80% of patients with Lyme disease

Question 8

What is the mx of acne?

Answer 8

Mild: combination of two: topical abx +/- topical benzoyl peroxide +/- topical retinoid (tretinoin, adapalene)

moderate to severe acne:
Topical retinoid/ benzoyl peroxide/ azelaic acid + PO abx or COCP for women

Topical and oral antibiotics should not be used in combination!!!

severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
oral isotretinoin: started by specialists only

Question 9

What rashes are associated with reactive arthiritis?
How is reactive arthirtis mx?

Answer 9

circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

NSAIDS
sulfasalazine and methotrexate are sometimes used for persistent disease

Question 10

What is Pityriasis rosea

Answer 10

May be proceded by viral infection
herald patch (usually on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

Question 11

Mx of rosacea?

Answer 11

mild-to-moderate papules and/or pustules:
topical ivermectin 1st line
alternatives include: topical metronidazole or topical azelaic acid

moderate-to-severe papules and/or pustules:
topical ivermectin + oral doxycycline

Steroids are CI!!! can make worse

Question 12

describe a dermatofibroma?

Answer 12

common, benign, fibrous nodule. Well defined, symmetrical, one colour.
dimple sign = dimples when it is pinched
may form in relation to trauma such as insect bites.
These lesions are often asymptomatic but may be associated with mild pain or itch.

Question 13

How do you differentiate between bullous pemphigoid or pemphigus vulgaris?

Answer 13

Both blisters/bullae

Tense blisters (deeper location) no mucosal involvement: bullous pemphigoid (avOID = NO mucosa)

flaccid blisters + mucosal involvement: pemphigus vulgaris (US = includes mucosa)

Question 14

What condition causes hair loss in localised regions with no scarring/ itching?

Answer 14

Alopecia areata

Question 15

Features of rosacea?

Answer 15

flushing of nose/ cheek/ forehead, pustules, Rhinophyma (bulbous nose), blepharitis, telangectasia
NOT itchy

Question 16

What rash is associated with coeliacs?

Answer 16

Dermatitis herpetiformis
itchy, vesicular skin lesions on the extensor surfaces

Question 17

tinea corporis vs erythema multiforme

Answer 17

tinea has single well-demarcated, erythematous circular patch with a raised edge and central hypopigmentation.

Erythrema multiforme has multiple separate spreading rings and usuallys viral cause/ drug cause

Question 18

Toxic epidermal necrolysis (TEN) vs Staphylococcal Scalded Skin syndrome (SSSS)

Answer 18

TEN:
Often triggered by meds eg anti-epileptics, abx, allopurinol, NSAIDs
extensive detachment of the epidermis, leading to the formation of large fluid-filled blisters that easily separate upon pressure. (+ve nikolskys)
Can cause AKI

SSSS:
Mostly children.
Not drug cause

Question 19

How urgently should you refer a BCC?

Answer 19

routine UNLESS eyes/ nose where further damage may occur

Question 20

What is the hutchinsons sign in shingles?

Answer 20

herpes zoster: This is Hutchinson’s sign which is strongly predictive for ocular involvement (anterior uveitis). rash @ tip of nose

Question 21

Mx of keloid scars?

Answer 21

early keloids may be treated with intra-lesional steroids e.g. triamcinolone

Question 22

What is pompholyx eczema?

Answer 22

Pompholyx, also known as dyshidrotic eczema, usually presents with small fluid-filled blisters/ vesicles on the palms of hands or soles of feet –> dry sesquamating phase

Flares up in heat/ humidity

Question 23

What causes Kaposis sarcoma?

Answer 23

Human herpes virus 8

Question 24

What is necrobiosis lipoidica?

Answer 24

Middle aged women with diabetes typically
bilateral erythematous plaques on shin with telangectasia
Yellow hue due to lipids deposition
may be asx/ itchy/ tender

Question 25

Drug causes of erythema multiforme?

Answer 25

penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine

Question 26

Stevens- johnson vs toxic epidermal necrolysis?

Answer 26

both drug reaction and mucus membranes, blistering

SJS - rash affecting <10% of body surface area

Toxic epidermal necrolysis at least 30% of body surface area

Question 27

What is palmoplantar pustulosis?

Answer 27

Fluid filled blisters on palms and feet - similar to pompholyx but is associated with psoriasis anf smoking and not associated with heat/ humidity

Question 28

What adverse effect can topical corticosteroids cause on dark skin?

Answer 28

patchy depigmentation

Question 29

What are the different causes of alopecia?

Answer 29

Scarring:
trauma, lichen planus, sicoid lupus, tinea capitis

Non-scarring:
male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
hair loss following stressful period e.g. surgery
trichotillomania

Question 30

Face flexural and genital psoriasis management

Answer 30

,

Outline
NICE recommend offering a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks

Question 31

Pemphigoid gestationis vs Polymorphic eruption of pregnancy vs Atopic eruption of pregnancy

Answer 31

Pemphigoid gestationis- blisters, starts peri-umbilical region, 2nd/ 3rd trimester, need PO steroids

Polymorphic eruption of pregnancy- last trimester, starts as abdo striae, treat with steroids (PO/ top) and emollients

Atopic eruption of pregnancy- most common, like eczema